Left atrial (LA) perfusion during disease states has been a topic of much interest, as the clinical implications and detrimental effects of lack of blood flow to the atria are numerous. In the chronic setting, perfusion changes may lead to LA ischemia and structural remodeling, a factor implicated in the self-perpetuation of chronic atrial fibrillation (AF). The association between AF and altered LA perfusion has been studied; however, a direct causal association between perfusion changes and AF has not been established. A comprehensive literature search of Medline, Embase and Google Scholar databases was conducted from 1960 to February 2014. We systematically analyzed reference lists of physiological articles and reviews for other possible relevant studies. This article is protected by copyright. All rights reserved.